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Objective: This study evaluates the contribution of energy-dense, nutrient-poor 'extra' foods to the diets of 16-24-month-old children from western Sydney, Australia.Design: An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either 'core' or 'extras' according to the Australian Guide to Healthy Eating.Setting: Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants' homes at the 18-month assessment.Participants: Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.Results: The mean consumption of 'extra' foods was approximately 150 g day(-1) and contributed 25-30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. 'Extra' foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of 'extra' foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of 'extra' foods was inversely associated with the intake of core foods.Conclusions: The high percentage of energy contributed by 'extra' foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1-2 years. These preliminary data on commonly consumed 'extra' foods and portion sizes may inform age-specific dietary assessment methods. [ABSTRACT FROM AUTHOR]

Objective: To examine statistical models that have been used to predict the cessation of breast-feeding.Setting: In nutritional epidemiology, a knowledge of risk factors that lead to breast-feeding cessation is essential to promote optimal infant health by increasing or sustaining breast-feeding rates. However, a number of methodological issues complicate the measurement of such risk factors. It is important when building multivariate models that variables entered into the model are not intervening variables, factors on the causal pathway or surrogate outcomes. Inclusion of these types of variable can lead to inaccurate models and biased results. A factor often cited to predict breast-feeding is 'intention to breast-feed' prior to the birth of the infant, although this factor is directly on the causal decision-making pathway. Another factor often cited is the age of introduction of formula feeding, which is actually part of the outcome variable because formula feeding defines the difference between full, complementary and no breast-feeding. Rather than include these as risk factors in multivariate models, factors removed from the causal pathway such as influences of educational practices, including advice to complementary feed, and beliefs and attitudes of families and health-care practitioners should be measured.Conclusions: The accurate quantification of modifiable risk factors is essential for designing public health education campaigns that are effective in sustaining or increasing breast-feeding duration. [ABSTRACT FROM AUTHOR]

CD14 influences postnatal switching of T helper cell responses. CD14 C-159T has been associated with altered CD14 and IgE levels in cross-sectional studies. Identifying whether associations vary with age requires data from children of the same age followed longitudinally over many years. In this study, an unselected population with extensive longitudinal data was used to test the hypothesis that CD14 C-159T was associated with early-onset atopy. A total of 305 subjects were assessed on up to seven occasions between ages 8 and 25 years by questionnaire, histamine challenge, and skin prick test. For atopy, airway hyperresponsiveness (AHR), and wheeze, each subject was classified as having early onset, late onset, or no disease onset during follow-up. Compared with subjects with -159CT and -159TT, subjects with -159CC had an odds ratio of 2.2 (p = 0.018) for early-onset atopy and an odds ratio of 2.6 (p = 0.019) for early-onset AHR. Cross-sectional analysis showed increased prevalence of -159CC in subjects with atopy and AHR in childhood but not adulthood. These data suggest that the influence of CD14 -159C on the atopic phenotype may be age specific, exerting an effect during midchildhood, which is no longer apparent by early adulthood. [ABSTRACT FROM AUTHOR]

Introduction: The association between snoring, nocturnal cough, and allergic symptoms in young children is not known.Objective: To measure the prevalence of habitual snoring and its association with nocturnal cough, asthma, and hay fever in preschool children.Setting: A cross-sectional study.Subjects: Preschool children aged 2 to 5 years.Method: The data were collected in a cross-sectional study. A total of 974 children were randomly selected from two areas of Lismore and Wagga Wagga in New South Wales, Australia.Results: The prevalence of snoring was 10.5%, with no gender difference (p = 0.99) or trend association with age (p = 0.58). The association between snoring and nocturnal cough was highly significant (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.41 to 5.63; p = 0.001). This association was significant in both the nonasthmatic and asthmatic groups when examined separately. Snoring was also significantly associated with asthma (OR, 2.03; 95% CI, 1.34 to 3.10; p = 0.001). In subjects without hay fever, the association between snoring and asthma was also highly significant (41.2% vs 24.8%; OR, 2.12; 95% CI, 1.34 to 3.37; p = 0.001).Conclusion: The prevalence of snoring in preschool children was 10.5% for both genders. Snoring was significantly associated with both nocturnal cough and asthma. Because snoring, asthma, and nocturnal cough may have a common etiology, it is possible that effective treatment of one symptom may lead to reductions in the presence or severity of the other symptoms. [ABSTRACT FROM AUTHOR]

Two main types of observational epidemiological studies have been used to question whether breastfeeding protects children from developing atopic disease and asthma. These are cohort studies of random samples of children and cohort studies of children with a family history of asthma or atopy. In each study type, exposure and outcome data are collected either prospectively or retrospectively. In this review, the primary objective was to assess the evidence of whether breastfeeding protects against asthma and atopic disease. As an outcome of this review, an analytical perspective with clinical implications is given. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to investigate the effectiveness of prostaglandin E2 vaginal gel as used in practice, rather than its efficacy as assessed in randomised, controlled, clinical trials. This product is used to ripen the cervix prior to induction of labour, sometimes making unnecessary the use of the standard treatment for induction, artificial rupture of the membranes (ARM) plus oxytocin. In this study, effectiveness of the gel was assessed in terms of changes in mode of delivery, and in particular the risk of Caesarean section. METHODS: An historical control was used and the risk of Caesarean section for women induced in the 1990/91 (before the introduction of the gel) was compared with that for women induced in 1992/93 (after the introduction of the gel). Maternal characteristics which may have been different in the two groups and factors which might influence the risk of Caesarean section were controlled for statistically using logistic regression, thus reducing any bias towards one group. RESULTS: After adjusting for the factors which had a significant effect on the process of labour from induction to birth, it was found that the risk of Caesarean section was not significantly lower in the 1992/93-time period, when the gel was in regular use, from that in the 2 years prior to its introduction (Odds ratio 1.09, CI95% 0.88, 1.36). CONCLUSION: Following the introduction of PGE2 gel, no difference in effectiveness, as measured in terms of mode of delivery, was detected in this study of practice, which included patients with more complex obstetric problems. [ABSTRACT FROM AUTHOR]

Picture Archiving and Communication Systems (PACS) make possible the viewing of radiographic images on computer workstations located where clinical care is delivered. By the nature of their work this feature is particularly useful for emergency physicians who view radiographic studies for information and use them to explain results to patients and their families. However, the high cost of PACS diagnostic workstations with fuller functionality places limits on the number of and therefore the accessibility to workstations in the emergency department. This study was undertaken to establish how well less expensive personal computer-based workstations would work to support these needs of emergency physicians. The study compared the outcome of observations by 5 emergency physicians on a series of radiographic studies containing subtle abnormalities displayed on both a PACS diagnostic workstation and on a PC-based workstation. The 73 digitized radiographic studies were randomly arranged on both types of workstation over four separate viewing sessions for each emergency physician. There was no statistical difference between a PACS diagnostic workstation and a PC-based workstation in this trial. The mean correct ratings were 59% on the PACS diagnostic workstations and 61% on the PC-based workstations. These findings also emphasize the need for prompt reporting by a radiologist. Copyright (c) 1998 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

Purpose: Improved mammographic sensitivity is associated with reduced mammographic density. This study aims to: provide a preliminary report on mammographic density among women in Riyadh; identify risk factors associated with mammographic density; and consider the potential implications for screening practices., Methods: Based on a cross-sectional design, we examined a total of 792 women using an area-based mammographic density method (LIBRA). Spearman's correlation, Mann-Whitney U, Kruskal-Wallis and binary logistic regression were used for analyses., Results: The study population had a mean age of 49.6 years and a high proportion of participants were overweight or obese (90%). A large number of women had low mammographic density, with a mean dense breast area of 19.1 cm 2 and percent density of 10.3 cm 2 . Slightly more than half of the variations in the dense breast area and percent density models were explained by BMI. In the adjusted analyses, BMI, menopausal status, age at menarche and number of children remained statistically significant predictors., Conclusion: Given the high proportion of women with low mammographic density, our findings suggest that women living in Riyadh may not require additional imaging strategies beyond mammography to detect breast cancers. The high proportion of obese women reported here and across Saudi Arabia suggests that mammographic density is less likely to have an adverse impact on mammographic sensitivity. Thus and to improve clinical outcomes among Saudi women, annual mammography and commencing screening at a younger age are suggested. Additional studies are required to shed further light on our findings., (Copyright © 2019. Published by Elsevier Inc.)

Objective: Mammographic density is an important risk factor for breast cancer and determines to a large extent mammographic screening efficacy. This study aims to provide baseline data for mammographic density profiling of women living in Ras Al Khaimah (RAK) and to identify risk factors associated with high mammographic density. Methods: A cross-sectional design was used to examine a series of 366 mammography cases. The Breast Imaging Reporting and Data System (BI-RADS, 5th edition) was used to evaluate mammographic density. Pearson’s chi-squared, Mann-Whitney U test and multivariate logistic regression were used for statistical analysis. Results: Most participants (67%) fell into BI-RADS b and c mammographic density categories. Of the total sample, women who were aged ≤ 45 years (p=0.004, OR=1.9), weighed ≤ 71kg (p=<0.0001, OR=4.8), had a body mass index of ≤ 27 kg/m2 (p=<0.0001, OR=5.1) and were of non-Arab descent (p=0.007, OR=1.8) were significantly more likely to have denser breast tissue. Adjusted ethnicity regression analysis showed that Emirati women were significantly less likely to have dense breast tissue compared with Western women (p=0.04, OR=0.4). Among the sample of survey participants, increased odds of having mammographic density were among women who were full-time workers (p=0.02, OR=2.8), of Christian faith (p=0.007, OR=4.4), nulliparous (p=0.003, OR=10.8), had three or fewer children (p=0.03, OR=3.8), and had used oral contraceptives for three years or more (p=0.01, OR=6.1). Conclusion: This study indicated that because Emirati women have a low mammographic density profile, screening mammography can be considered as an effective early detection imaging modality., (Creative Commons Attribution License)

Background: In recent decades the amount of new breast cancer cases in the southern region has been reported to increase more rapidly than in the northernVietnam. The aim of this study is to compare breast cancer risk factors between the two regions and establish if westernized influences have an impact on any reported differences. Method: Data was collected from the two largest oncology hospitals in the north and the south of Vietnam in 2015. Breast density, demographic, reproductive and lifestyle data of 127 cases and 269 controls were collected in the north and 141 cases and 250 controls were gathered from the south. Baseline differences in factors between cases and age-matched controls in each region were assessed using chi-square tests and independent t-tests. Odds ratios (OR) for independent risk factors for breast cancer were obtained from conditional logistic regression. Results: In northern Vietnam significantly increased risks in developing breast cancer were observed for women with age at first menstrual period less than 14 years old (OR=2.1; P<0.05), post-menopausal status (OR=2.6; P<0.0001), having less than 2 babies (OR=2.1; P<0.05). Southern Vietnamese women having a breast density of more than 75% (OR=2.1; P<0.01), experiencing post-menopause (OR=1.6; P<0.05), having a history of less than 3 pregnancies (OR=2.6; P<0.0001) and drinking more than a cup of coffee per day (OR=1.9; P<0.05) were more likely to be diagnosed with breast cancer. Conclusion: We found that women living in the south had some breast cancer associations, such as increased mammographic density and coffee consumption, which are closer to the risks in westernized populations than women in the north., (Creative Commons Attribution License)

Purpose: Rates of women with breast cancer have increased rapidly in recent years in Vietnam, with over 10,000 new patients contracting the disease every year. This study was conducted to identify demographic, reproductive and lifestyle risk factors for breast cancer in Vietnam., Materials and Methods: Breast density, demographic, reproductive and lifestyle data of 269 women with breast cancer and 519 age-matched controls were collected in the two largest oncology hospitals in Vietnam (one in the north and one in the south). Baseline differences between cases and controls in all women, premenopausal and postmenopausal women were assessed using chi-squared tests and independent t tests. Conditional logistic regression was used to derive odds ratios (OR) for factors that had statistically significant associations with breast cancer., Results: Vietnamese women with breast cancer were significantly more likely to have a breast density > 75% (OR, 1.7), be younger than 14 years at first menstrual period (OR, 2.2), be postmenopausal (OR, 2.0), have less than three pregnancies (OR, 2.1), and have less than two babies (OR, 1.7). High breast density (OR, 1.6), early age at first menstrual period (OR, 2.6), low number of pregnancies (OR, 2.3), hormone use (OR, 1.8), and no physical activities (OR, 2.2) were significantly associated with breast cancer among premenopausal women, while breast density (OR, 2.0), age at first menstrual period (OR, 1.8), number of pregnancies (OR, 2.3), and number of live births (OR, 2.4) were the risk factors for postmenopausal women., Conclusion: Breast density, age at first menarche, menopause status, number of pregnancies, number of babies born, hormone use and physical activities were significantly associated with breast cancer in Vietnamese women.

The aim of this study was to investigate how breast density interacted with demographic, reproductive, and lifestyle features among Vietnamese women. Mammographic density and established risk factors for breast cancer were collected from 1651 women (345 cancer cases and 1306 normal cases) in Vietnam. The association of breast density categories with potential risk factors was investigated using Spearman's test for continuous variables and χ 2 tests for categorical variables. Independent factors associated with high breast density and breast cancer in specific density groupings were assessed using logistic regression. Results showed that high breast density was significantly associated with young age, low body mass index, low number of children, early age at having the last child, premenopausal status, and increased vegetable consumption. Reproductive factors were key agents associated with breast cancer for women with high breast density, which was not so evident for women with low breast density.

Background: Young women are under-represented in cardiovascular disease research, with obesity and cardiometabolic risk factor interventions generally targeting older adults. Furthermore, appropriate study designs for young women remain uncertain. This study aimed to assess the impact of a 12 week multi-disciplinary lifestyle intervention on cardiometabolic risk factors in premenopausal women with abdominal obesity., Methods: Women aged 18-30 y with abdominal obesity [waist circumference (WC) ≥ 80 cm] were randomised to a 12 week lifestyle intervention (n = 26) of physical activity, nutrition education and cognitive behavioural therapy, or a wait-list control group (n = 17). Both groups completed anthropometric, biochemical, nutrition and fitness testing, at pre (0 weeks) and post (12 weeks), with intervention participants completed follow-up testing at 24 weeks., Results: Results from a linear mixed model showed no between-group differences, other than increased physical activity in the intervention group, at post. In the intervention group alone, positive within-group changes were observed in WC, waist-hip-ratio (WHR), waist-height-ratio (WHtR), resting heart rate, blood pressure, predicted VO2max, and total energy intake. Most changes were maintained at 24 weeks post-intervention. Similar within-group improvements were observed in control participants in WC, WHR, WHtR, and systolic blood pressure but no changes were detected in physical activity and nutrition., Conclusions: Cardiometabolic risk factors were decreased as a result of a lifestyle intervention in young women with abdominal obesity. It is difficult to describe observations in the control group without greater understanding of the behaviour of wait-list participants., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612001017819.

Background: Malnutrition and elevated inflammatory markers have a negative impact on clinical outcomes in cancer patients. Few studies have investigated the associations between inflammatory makers, nutritional status and survival. This study investigates the association between nutritional status, inflammatory markers and overall survival (OS) in patients with advanced cancer., Methods: This prospective cohort study recruited 114 adult patients from January 2007 to January 2010. It included patients diagnosed with advanced cancer, good Eastern Cooperative Oncology Group (ECOG) performance status 0-2, a prognosis of more than 3 months and had not received chemotherapy for advanced cancer prior to enrollment. Baseline data were collected prior to commencement of chemotherapy. Patients were followed up from the date of baseline nutritional assessment until the date of death or the date that data were last updated, whichever came first., Results: Malnourished cancer patients had statistically significant higher concentrations of serum C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) or modified Glasgow Prognostic Score (mGPS) prior to starting chemotherapy. In univariate analyses to predict survival, mGPS 1 or 2 had a hazard ratio (HR) of 1.81 (95 % confidence interval (CI) 1.13-2.89) and NLR ≥ 5 had a HR of 1.13 (95 % CI 1.08-4.60) and malnutrition (HR of 1.66 for Patient-Generated Subjective Global Assessment (PG-SGA) B (95 % CI 1.02-2.71), and HR for severely malnourished patients (PG-SGA C) was 2.73 (95 % CI 1.50-4.96)., Conclusions: Inflammatory markers were statistically associated with malnutrition. Malnutrition and mGPS were significant independent predictors of overall survival in patients with advanced cancer.

Objectives: This study aimed to (1) investigate cardiometabolic risk markers in young women (18-30 years) with overweight/obesity, and (2) establish whether the measures of waist circumference and body mass index possess similar associations of cardiometabolic risk., Design: Cross-sectional., Methods: Cardiometabolic risk factors including, anthropometric, metabolic syndrome markers, biochemical, and other health/fitness indicators were assessed in women when classified as overweight/obese by waist circumference [waist circumference 91.9 ± 10.1 cm, age 22.3 ± 3.5 years, n = 38] versus control [n = 30, waist circumference 71.4 ± 3.5 cm, age 20.1 ± 0.9 years], and when classified by body mass index [n=35, body mass index 32.2 ± 5.2 kg m(2), age 22.5 ± 3.6 years] versus control [body mass index 21.7 ± 1.9 kg m(2), age 20.1 ± 0.9 years, n=33]., Results: Compared with controls, women with overweight/obesity (classified by waist circumference or body mass index) displayed elevated body mass, systolic blood pressure and homeostasis model assessment of insulin resistance, and reduced estimated [Formula: see text] and weekly physical activity, with no differences in self-reported energy intake. The unadjusted odds ratio of being classified with overweight/obesity and an elevated homeostasis model assessment of insulin resistance and/or less than recommended physical activity ranged between 5.1 and 10.0. Receiver operator characteristic curves indicated waist circumference, body mass index and waist-to-height ratio cut-off points of ≥ 84.2 cm, ≥ 30.6 kg m(-2) and ≥ 0.5, respectively, for homeostasis model assessment of insulin resistance, and ≥ 80.6 cm, ≥ 25.2 kg m(-2) and ≥ 0.46, respectively, for less than recommended physical activity., Conclusions: Waist circumference and body mass index have similar associations with cardiometabolic risk, with greater homeostasis model assessment of insulin resistance and lower physical activity, rather than differences in traditional metabolic syndrome markers, observed in young women with overweight/obesity., (Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effectiveness of the Practitioner Asthma Communication and Education (PACE) Australia program, an innovative communication and paediatric asthma management program for general practitioners., Design: Randomised controlled trial., Setting: General practices from two regions in metropolitan Sydney., Participants: 150 GPs, who were recruited between 2006 and 2008, and 221 children with asthma in their care., Intervention: GPs in the intervention group participated in two 3-hour workshops, focusing on communication and education strategies to facilitate quality asthma care., Main Outcome Measures: Patient outcomes included receipt of a written asthma action plan (WAAP), appropriate medication use, parent days away from work, and child days away from school or child care. GP outcomes included frequency of providing a WAAP and patient education, communication and teaching behaviour, and adherence to national asthma guidelines regarding medication use., Results: More patients of GPs in the intervention group reported receipt of a WAAP (difference, 15%; 95% CI, 2% to 28%; adjusted P=0.046). In the intervention group, children with infrequent intermittent asthma symptoms had lower use of inhaled corticosteroids (difference, 24%; 95% CI, -43% to -5%; P=0.03) and long-acting bronchodilators (difference, 19%; 95% CI, -34% to -5%; P=0.02). GPs in the intervention group were more confident when communicating with patients (difference 22%; 95% CI, 3% to 40%; P=0.03). A higher proportion of GPs in the intervention group reported providing a WAAP more than 70% of the time (difference, 23%; 95% CI, 11% to 36%; adjusted P=0.002) and prescribing spacer devices more than 90% of the time (difference, 29%; 95% CI, 16% to 42%; adjusted P=0.02)., Conclusions: The PACE Australia program improved GPs' asthma management practices and led to improvements in some important patient outcomes., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000067471.

Background: There is a need for valid population level measures of physical activity in young children. The aim of this paper is to report the development, and the reliability and validity, of the Preschool-age Children's Physical Activity Questionnaire (Pre-PAQ) which was designed to measure activity of preschool-age children in the home environment in population studies., Methods: Pre-PAQ was completed by 103 families, and validated against accelerometry for 67 children (mean age 3.8 years, SD 0.74; males 53%). Pre-PAQ categorizes activity into five progressive levels (stationary no movement, stationary with limb or trunk movement, slow, medium, or fast-paced activity). Pre-PAQ Levels 1-2 (stationary activities) were combined for analyses. Accelerometer data were categorized for stationary, sedentary (SED), non-sedentary (non-SED), light (LPA), moderate (MPA) and vigorous (VPA) physical activity using manufacturer's advice (stationary) or the cut-points described by Sirard et al and Reilly et al. Bland-Altman methods were used to assess agreement between the questionnaire and the accelerometer measures for corresponding activity levels. Reliability of the Pre-PAQ over one week was determined using intraclass correlations (ICC) or kappa (κ) values and percentage of agreement of responses between the two questionnaire administrations., Results: Pre-PAQ had good agreement with LPA (mean difference 1.9 mins.day⁻¹) and VPA (mean difference -4.8 mins.day⁻¹), was adequate for stationary activity (mean difference 7.6 mins.day⁻¹) and poor for sedentary activity, whether defined using the cut-points of Sirard et al (mean difference -235.4 mins.day⁻¹) or Reilly et al (mean difference -208.6 mins.day⁻¹) cut-points. Mean difference between the measures for total activity (i.e. Reilly's non-sedentary or Sirard's LMVPA) was 20.9 mins.day⁻¹ and 45.2 mins.day⁻¹. The limits of agreement were wide for all categories. The reliability of Pre-PAQ question responses ranged from 0.31-1.00 (ICC (2, 1)) for continuous measures and 0.60-0.97 (κ) for categorical measures., Conclusions: Pre-PAQ has acceptable validity and reliability and appears promising as a population measure of activity behavior but it requires further testing on a more broadly representative population to affirm this. Pre-PAQ fills an important niche for researchers to measure activity in preschool-age children and concurrently to measure parental, family and neighborhood factors that influence these behaviors.

Background: In developing countries, infectious diseases such as diarrhoea and acute respiratory infections are the main cause of mortality and morbidity in infants aged less than one year. The importance of exclusive breastfeeding in the prevention of infectious diseases during infancy is well known. Although breastfeeding is almost universal in Bangladesh, the rates of exclusive breastfeeding remain low. This cohort study was designed to compare the prevalence of diarrhoea and acute respiratory infection (ARI) in infants according to their breastfeeding status in a prospective cohort of infants from birth to six months of age., Methods: A total of 351 pregnant women were recruited in the Anowara subdistrict of Chittagong. Breastfeeding practices and the 7-day prevalence of diarrhoea and ARI were recorded at monthly home visits. Prevalences were compared using chi-squared tests and logistic regression., Results: A total of 272 mother-infant pairs completed the study to six months. Infants who were exclusively breastfed for six months had a significantly lower 7-day prevalence of diarrhoea [AOR for lack of EBF = 2.50 (95%CI 1.10, 5.69), p = 0.03] and a significantly lower 7-day prevalence of ARI [AOR for lack of EBF = 2.31 (95%CI 1.33, 4.00), p < 0.01] than infants who were not exclusively breastfed. However, when the association between patterns of infant feeding (exclusive, predominant and partial breastfeeding) and illness was investigated in more detail, there was no significant difference in the prevalence of diarrhoea between exclusively [6.6% (95% CI 2.8, 10.4)] and predominantly breastfed infants [3.7% (95% CI 0.09, 18.3), (p = 0.56)]. Partially breastfed infants had a higher prevalence of diarrhoea than the others [19.2% (95% CI 10.4, 27.9), (p = 0.01)]. Similarly, although there was a large difference in prevalence in acute respiratory illness between exclusively [54.2% (95%CI 46.6, 61.8)] and predominantly breastfed infants [70.4% (95%CI 53.2, 87.6)] there was no significant difference in the prevalence (p = 0.17)., Conclusion: The findings suggest that exclusive or predominant breastfeeding can reduce rates of morbidity significantly in this region of rural Bangladesh.

Background: This study was commenced in 1999 with the aim of examining risk factors for autism using established population-based data for comparison., Methods: Cases were ascertained using active surveillance and compared with birth data., Results: Four risk factors were found to be significantly associated with autism using binary logistic regression analysis; being male [adjusted odds ratio (OR) 4.7, 95% confidence interval (CI) 3.2-7.0], being born prematurely (adjusted OR 2.2, 95% CI 1.5-3.5), having maternal age >/=35 years (adjusted OR 1.7, 95% CI 1.2-2.4) and having a mother born outside Australia (adjusted OR 1.4, 95% CI 1.0-1.9). For analysis completed for pregnancies, rather than live births, multiple birth was also a significant risk factor for one or more children of the pregnancy to be affected by autism (adjusted OR 2.5, 95% CI 1.1-5.5). There was a statistically significant trend towards increasing risk with increasing risk factor 'dose' for gestational age (P = 0.019), multiple birth (P = 0.016) and maternal age (P < 0.001). For mother's country of birth the group with the highest risk were children of mother's born in south-east or north-east Asia. There was a non-significant trend towards a higher proportion of children with developmental disability having risk factors., Conclusion: Replication of risk factors from previous studies and a significant risk factor 'dose' effect add to growing evidence that maternal and perinatal factors are low magnitude risk factors for autism. The association between developmental disability and autism risk factors warrants further examination.

Aim: To describe the use of diagnostic labels by clinicians for children with autism spectrum disorders (ASD) and calculate the label-specific and overall agreement between diagnostic labels and Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) diagnoses provided by the same clinician., Methods: State-wide active surveillance was used to ascertain children newly recognised with one or more DSM-IV criteria for autistic disorder aged 0-15 years (incident cases) in New South Wales (NSW) between July 1999 and December 2000. Clinicians were asked to supply a diagnostic label and then complete DSM-IV criteria for each child reported., Results: Questionnaires with diagnostic label and DSM-IV criteria were returned for 348 children. The agreement between labels used and diagnosis based on DSM-IV classification system was the highest for autism (97%) and lower for labels of Asperger disorder, pervasive developmental disorder - not otherwise specified or atypical autism (27%). Kappa overall agreement was 0.31. Level of agreement between label and DSM-IV diagnosis was similar for questionnaires completed by multidisciplinary teams, psychiatrists, paediatricians and psychologists working as part of a team., Conclusion: A lack of agreement between the diagnostic labelling used by clinicians and diagnosis based on DSM-IV criteria indicates a lack of consistency in diagnostic communication that is necessary to provide best clinical care, appropriate services and relevant information to parents and carers.

The objective of this study was to investigate the association between the prevalence of exclusive breastfeeding and morbidity (diarrhoeal diseases and acute respiratory infection) in infants aged 0-3 month(s) using the Multiple Indicator Cluster Survey (MICS) 2003 data from Bangladesh. The study population included 1633 infants aged 0-3 month(s). The prevalence of diarrhoea and acute respiratory infection was compared using the chi-square tests between infants aged 0-3 month(s) who were exclusively breastfed and infants who were not exclusively breastfed. Logistic regression was used to adjust for confounders and for calculating adjusted odds ratios. To adjust for cluster sampling and reduced variability, the adjusted chi-square value was divided by the design effect, and a re-estimated p value was calculated. The prevalence of diarrhoea and acute respiratory infection in this sample of 0-3-month old infants in Bangladesh was 14.3% and 31.2% respectively. The prevalence of both illnesses was significantly associated with lack of exclusive breastfeeding. The adjusted odds ratio for diarrhoea was 0.69 (95% confidence interval [CI] 0.49-0.98, p = 0.039), and the adjusted odds ratio for acute respiratory infection was also 0.69 (95% CI 0.54-0.88, p = 0.003). Only 192 infants (11.7% of total sample) were exclusively breastfed at the time of interview, and 823 infants (50.3%) were never exclusively breastfed. The prevalence of prelacteal feeding was 66.6%. The results confirmed a protective effect of exclusive breastfeeding against infectious diseases-related morbidity in infancy and showed that frequently-collected cross-sectional datasets could be used for estimating effects. The low prevalence of exclusive breastfeeding in Bangladesh needs to be improved to decrease child morbidity.

Background: Early life exposures may be important in the development of asthma and allergic disease., Objective: To test house dust mite (HDM) avoidance and dietary fatty acid modification, implemented throughout the first 5 years of life, as interventions to prevent asthma and allergic disease., Methods: We recruited newborns with a family history of asthma antenatally and randomized them, separately, to HDM avoidance or control and to dietary modification or control. At age 5 years, they were assessed for asthma and eczema and had skin prick tests for atopy., Results: Of 616 children randomized, 516 (84%) were evaluated at age 5 years. The HDM avoidance intervention resulted in a 61% reduction in HDM allergen concentrations (microg/g dust) in the child's bed but no difference in the prevalence of asthma, wheeze, or atopy (P > .1). The prevalence of eczema was higher in the active HDM avoidance group (26% vs 19%; P = .06). The ratio of omega-6 to omega-3 fatty acids in plasma was lower in the active diet group (5.8 vs 7.4; P < .0001). However, the prevalence of asthma, wheezing, eczema, or atopy did not differ between the diet groups (P > .1)., Conclusion: Further research is required to establish whether other interventions can be recommended for the prevention of asthma and allergic disease., Clinical Implications: House dust mite avoidance measures and dietary fatty acid modification, as implemented in this trial during infancy and early childhood, did not prevent the onset of asthma, eczema, or atopy in high-risk children.

Objective: Proteins are the major effectors of biological structure and function. Oxidation-induced changes to protein structure can critically impair protein function, with important pathologic consequences. This study was undertaken to examine whether oxidation-induced changes to protein structure occur during pediatric cardiopulmonary bypass and to examine the association with postoperative outcome., Methods: Elevation of the 3,4-dihydroxyphenylalanine content of a protein relative to its native tyrosine content indicates structural damage due to oxidation. Protein 3,4-dihydroxyphenylalanine/native tyrosine ratios were measured before surgery and up to 6 hours after institution of cardiopulmonary bypass in 24 children undergoing repair of congenital heart disease, who were prospectively selected to form a cyanotic and comparable acyanotic control group. Results were correlated with perioperative variables and postoperative outcomes., Results: Elevation of protein 3,4-dihydroxyphenylalanine/tyrosine ratios above baseline (0.48 mmol/mol [SD, 0.11 mmol/mol] vs 0.36 mmol/mol [SD, 0.13 mmol/mol]; P = .001) occurred within 30 minutes of initiating cardiopulmonary bypass in cyanotic but not in acyanotic children and correlated inversely with preoperative arterial oxygen saturation (R = -0.52; P = .03). Protein 3,4-dihydroxyphenylalanine/tyrosine ratios were also increased above baseline at 120 minutes (0.44 mmol/mol [SD, 0.12 mmol/mol]; P = .007) and 180 minutes (0.40 mmol/mol [SD, 0.14 mmol/mol]; P = .01) after the institution of cardiopulmonary bypass in children who underwent prolonged procedures. Elevation of 3,4-dihydroxyphenylalanine/tyrosine during prolonged procedures was associated with postoperative arrhythmias and the need for increased inotropic support (P = .001)., Conclusions: Oxidative injury to proteins occurs during pediatric cardiopulmonary bypass. Cyanotic children are most at risk, particularly those undergoing prolonged procedures, in whom elevation of the protein 3,4-dihydroxyphenylalanine/tyrosine ratio is associated with increased postoperative morbidity.

The objective of this study was to assess the relation between observed levels of omega-3 fatty acids in plasma and symptoms of asthma and atopy in children at 18 months of age. A total of 616 women at risk of having a child who would develop asthma because of a family history were recruited from the antenatal clinics of six hospitals in Sydney, Australia. Families were randomized to either active omega-3 supplemented or control group. The active group received a daily tuna fish oil supplement and omega-3-rich margarines and cooking oils and the control group received a placebo supplement with polyunsaturated margarines and cooking oils. When the children were 18 months of age an assessment of symptoms was carried out by a research nurse blinded to treatment group allocation. Atopy was measured by skin prick tests, blood was collected to determine serum immunoglobulin E (IgE), and plasma fatty acid concentrations. A total of 376 children (61.0% of total recruited) completed an assessment at 18 months and had blood taken to determine plasma fatty acid concentrations. Omega-3 fatty acid levels were expressed in quintiles of exposure 'as treated' without reference to treatment group allocation. Wheeze ever, doctor visits for wheeze, bronchodilator use and nocturnal coughing were significantly reduced in children in the higher exposure quintiles. Serum IgE was reduced in the highest quintile but not significantly so. There was no difference in diagnosed asthma or atopy between the exposure quintiles. Although wheeze at this age may not be a good indicator of asthma in later childhood, it is encouraging that some symptoms have been reduced in children with high omega-3 fatty acid concentrations in plasma.

Background: Two factors thought to influence the risk of asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids. Although house dust mite allergen avoidance has been used as a preventive strategy in several trials, the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known., Objective: To measure the effects of dietary supplementation with omega-3 fatty acids and house dust mite allergen avoidance in children with a family history of asthma., Methods: A total of 616 children at high risk of asthma were enrolled antenatally in a randomized controlled trial, and 526 children remained in the trial at age 3 years. The outcomes were symptoms of allergic disease and allergen sensitization., Results: There was a significant 10.0% (95% CI, 3.7-16.4) reduction in the prevalence of cough in atopic children in the active diet group ( P=.003; number needed to treat, 10) but a negligible 1.1% (95% CI, -7.1 to 9.5) reduction cough among nonatopic children. There was a 7.2% (95% CI, 10.11-14.3) reduction in sensitization to house dust mite in the active allergen avoidance group ( P=.05; number needed to treat, 14). No significant differences in wheeze were found with either intervention., Conclusion: These results suggest that our interventions, designed to be used in simple public health campaigns, may have a role in preventing the development of allergic sensitization and airways disease in early childhood. This offers the prospect of reducing allergic disease in later life.

Background: Little is known about the natural course of persistent rhinitis symptoms over a prolonged period., Objective: To describe the frequency and severity of nasal symptoms and quality of life (QoL) in house dust mite-sensitive persistent rhinitic subjects and to determine if medication use was related to symptoms., Methods: Rhinitics and controls were telephoned fortnightly for 1 year to monitor symptoms. QoL was measured every 3 months., Results: Thirty-seven rhinitics and 19 controls completed the study. Total nasal symptom scores (TNSS) were 'high' for 65% (95% CI +/- 6%) of the year in rhinitic subjects. When TNSS increased by 1, the likelihood of nasal medication use increased by 25% (95% CI: 7-46%). General and specific QoL were worse in rhinitic subjects than controls (P < 0.04 and <0.0001). Rhinitics with pollen allergy (n = 21) had seasonal variation in the frequency of high nasal symptom scores (P = 0.02)., Conclusion: Nasal symptom scores were consistently high in rhinitics, and their QoL was worse than controls, even in general QoL. An increase in nasal symptom score increased the likelihood of nasal medication use. These findings help to characterize the course of persistent rhinitis over a previously unstudied period of 1 year.

Background: The association between nasal and bronchial symptoms, and the course of bronchial responsiveness and airway inflammation in house dust mite sensitive persistent rhinitis over a prolonged time period has not been thoroughly explored., Objective: To determine if nasal symptoms were associated with bronchial symptoms in persistent rhinitic subjects, and to assess their bronchial responsiveness and airway inflammation in comparison to nonrhinitic, nonatopic controls. The additional impact of pollen sensitivity on the lower airways in rhinitic subjects was also addressed., Methods: Rhinitics and controls answered telephone symptom questionnaires once every 2 weeks for 1 year. Every 3 months, exhaled nitric oxide (eNO) and bronchial responsiveness to histamine were measured., Results: Thirty-seven rhinitics and 19 controls completed the study. High nasal symptom scores in rhinitic subjects were associated with bronchial symptoms (OR = 1.7, 95% CI 1.2-2.5). Bronchial hyper-responsiveness was present in 32.4% of rhinitic subjects on at least one clinical visit during the year. Pollen allergy caused seasonal variation in eNO (P = 0.03)., Conclusion: In persistent rhinitic subjects, high nasal symptom scores were associated with bronchial symptoms, and many subjects experienced bronchial hyper-responsiveness during the year. Persistent rhinitic subjects were more at risk than healthy adults of bronchial symptoms and airway inflammation, which are likely risk factors for asthma.

Objective: To investigate the growth and feeding practices in first-generation Vietnamese infants living in Australia., Design: Cohort study., Setting: The study was conducted between 1999 and 2002 in Sydney., Subjects: A total of 239 Vietnamese women were recruited randomly from antenatal clinics, and of these 210 were initially seen. During the first year, 20 cases (9.5%) were lost to follow-up. Data were collected at 0.5, 2, 4, 6, 9 and 12 months., Results: Vietnamese infants were significantly longer and heavier than reference data (both P<0.0001). The Vietnamese infants had a significant decline in weight growth with age compared with reference data (P<0.001). The Vietnamese infants had marginally higher s.d. score for ideal weight for length than reference data (P=0.044). There was a significant decline in ideal weight for length with age compared with reference data (P=0.0065). Both parents were significantly shorter (mean s.d. height scores: -1.5+/-0.8 (mother) and -1.8+/-0.8 (father)) than reference data (P<0.001). The incidence of breast feeding was 79%, but half of the breast feeding women had stopped breast feeding by 3 months. A total of 162 (79.8%) infants were given infant formula within the first week, of whom 131 (80.1%) were fed infant formula within the first 24 h after birth., Conclusions: Vietnamese infants in this study had growth comparable with reference data despite their parents being shorter than reference data. Breast feeding duration was short with infant formula being introduced early.

Unlabelled: Asthma is a leading cause of morbidity for children and is a major public health problem in Australia. Ecological and temporal data suggest that dietary factors may have a role in recent increases in the prevalence of asthma., Aim: The aim of conducting this study was to investigate whether childhood asthma was associated with the ratio of omega 6 (n-6) to omega 3 (n-3) fatty acids in the diet (n-6:n-3)., Method: The Western Australian Pregnancy Cohort Study is a prospective birth cohort of 2602 children. Using a nested case-control cross-sectional study design within this cohort, a group of children were identified as cases with current asthma at 6 or at 8 years of age or as controls with no asthma at 6 or at 8 years. Dietary details including n-6 and n-3 fatty acid intake data were collected by parent response to a questionnaire when the children were 8 years old. Logistical regression was used to compare quartiles of n-6:n-3 intake in cases and controls. Adjustment was made for covariates: gender, gestational age, breastfeeding, older siblings, maternal smoking during pregnancy, maternal age, maternal asthma, child's current age in months, body mass index, total energy intake, and antioxidant intake (vitamins A, C, E, and zinc)., Results: A response rate of 83% was achieved by providing complete data from 335 children [49% cases with current asthma (n = 166), 51% controls (n = 169)]. Following adjustment for covariates the association between the ratio of n-6:n-3 fatty acids and risk for current asthma was statistically significant (p = 0.022)., Conclusion: We found evidence for a modulatory effect of the dietary n-6:n-3 fatty acid ratio on the presence of asthma in children. Our results provide evidence that promotion of a diet with increased n-3 fatty acids and reduced n-6 fatty acids to protect children against symptoms of asthma is warranted.